Engaging HIV-HCV co-infected patients in HCV treatment: the roles played by the prescribing physician and patients' beliefs (ANRS CO13 HEPAVIH cohort, France)

We used 3-year follow-up data from the HEPAVIH ANRS-CO13 nationwide French cohort which enrolled patients living with HIV and HCV. We included pegylated interferon and ribavirin-naive patients (N = 600) at enrolment. Clinical/biological data were retrieved from medical records. Self-administered questionnaires were used for both physicians and their patients to collect data about experience and behaviors, respectively.Median [IQR] follow-up was 12[12-24] months and 124 patients (20.7%) had started HCV treatment. After multiple adjustment including patients' negative beliefs about HCV treatment, those followed up by a general practitioner working in a hospital setting were more likely to receive HCV treatment (OR[95%CI]: 1.71 [1.06-2.75]). Patients followed by general practitioners also reported significantly higher levels of alcohol use, severe depressive symptoms and poor social conditions than those followed up by other physicians.Hospital-general practitioner networks can play a crucial role in engaging patients who are the most vulnerable and in reducing existing inequities in access to HCV care. Further operational research is needed to assess to what extent these models can be implemented in other settings and for patients who bear the burden of multiple co-morbidities.Liver fibrosis progresses faster in HIV-HCV co-infected patients than among those with HCV alone [1]. While AIDS mortality has decreased sharply since the widespread introduction of antiretroviral treatment (ART) in 1996, end stage liver diseases now represent one of the leading causes of death in this population [2-5].Treatment for HCV is available and cost-effective [6]; it cures 45% of patients with HCV genotype 1 infection and 75% of those with HCV genotype 2 or genotype 3 infection [7-9]. The current recommendations for the treatment of hepatitis C in mono-infected and HIV-HCV co-infected patients are much more liberal than before [10,11]. Previous indications which tended to delay or deny